ICU Transfer Policy
The following policy has been developed in order to facilitate effective transfer of care from anesthesia and surgery to the ICU physicians who will care for them. Anesthesia residents and staff should note that transfer of postoperative care in the ICU setting is different than standard PACU transfers. ICU Physicians and nurses must be fully and directly informed of the patient's perioperative course of events and postoperative medical status. Transport to ICU from OR should always include:
- Send a "45": The ICU requires 45 minutes notice for transfer of a patient from the operating room. In the past, this was a paper form that was submitted by a nurse to the ICU. This is now done on the computer. Using EPIC, compose an ICU transfer note, indicate vent settings e.g.: Mode SIMV, Vt 800 RR 10, FIO2 100% , PS (pressure support =5), PEEP 5 (unless contraindicated).
- Prepare equipment and drugs for transport: Jackson/Rees breathing system during transport if intubated, if not JR or mask O2. Intubation set-up (blade, styletted ETT 6.0 available, oral/nasal airway). Emergency drugs (sux, STP, ephedrine, phenylephrine, esmolol, atropine). Request transport monitor from anesthesia tech.
- Transfer of Care in ICU: Upon arrival in the ICU report to nurse and ICU MD and write short ICU post-op note. Be sure that your post-anesthesia ICU note includes fluid summary, residual anesthetics (narcotics, relaxants), current vasoactive drug therapy, regional anesthetic (e.g. epidural/spinal level postop) and ventilatory management.
- Communicate to ICU Physician: Communicate clearly to ICU Fellow regarding follow up patient care issues: e.g. CXR for CVP/PA or ETT placement (5cm above carina) consider complications: PTX, main stem intubation, balloon rupture, mucus plugging, atelectasis, aspiration. Do not leave patient without verifying proper function of CVP, PA catheter, if in use, including PAOP.
- Problems?: If there is any difficulty contacting an ICU resident, please call the ICU fellow spectrolink phone, 4-8820
- No ICU Beds?: If the patient is going to the PACU because there are no ICU beds available, but is going to the ICU as one becomes available, please signout to the ICU service on arrival to the PACU.
